BUSINESS VISA CARD APPLICATION Classic Platinum Fixed Rate Variable Rate Applicant Information Name City Street Address State Zip Code Telephone Number Type of Business State and County Where Organized Tax ID Number Date Started Type of Organization: Corporation Partnership Proprietorship LLC List: Principal Owners (if Proprietorship), Partners (if Partnership), Officers (if Corporation) Name Address Phone Number Social Security No. Date of Birth Age Title % of Ownership Personal Financial Statement Enclosed? Name of Company: (This name will be embossed on all cards) Account Number: al 07/2017
Card #1 Card #2 Card #3 Card #4 Name/Title: Requested Credit Limit: SS No. DOB Member No. Signature: Name/Title: Requested Credit Limit: SS No. DOB Member No. Signature: Name/Title: Requested Credit Limit: SS No. DOB Member No. Signature: Name/Title: Requested Credit Limit: SS No. DOB TOTAL REQUESTED CREDIT: Member No. Signature: Remit with current Business Tax Return and Profit/Loss Statement & Balance Sheet Non-Profit Organizations: Remit Current Annual Financial Report Only The Credit Union is authorized to rely on the information provided in this Agreement and Authorization until it receives written notice of change. In the case of corporations and associations, this notice must be in the form of a resolution, certified by the Secretary. In the case of a partnership, all partners must sign this notice. The above persons are officers or agents authorized to use Credit Cards pursuant to Coast Central Credit Union VISA Credit Card Agreement, receipt of which is hereby acknowledged by the undersigned on behalf of the Company named above. By: Date By: Date Authorized Signature Authorized Signature Print or Type Name and Title: Print or Type Name and Title: By: Date By: Date Authorized Signature Authorized Signature Print or Type Name and Title: Print or Type Name and Title: FOR CREDIT UNION USE ONLY Date Approved Limits: Card #1 Card #2 Card #3 Card #4 Total Advance Approved: Yes No Counter offer will be made, if accepted advance approval Describe Counter Offer or Specific Reasons for Rejection: Approving Loan Officer Signature Date Notice and Reason for Rejection Sent or Delivered on by (Initials) Additional 1. Signatures, 2. if needed 3.
PERSONAL FINANCIAL STATEMENT IMPORTANT: Read these directions before completing the Statement. If you are applying for individual credit in your own name and are relying on your own income or assets and not the income or assets of another person as the basis for repayment of the credit requested, complete only Sections 1 and 3. If you are applying for joint credit with another person, complete all Sections providing information in Section 2 about the joint applicant. If you are applying for individual credit, but are relying on income from alimony, child support, or separate maintenance or on the income or assets of another person as a basis for repayment of the credit requested, complete all sections, providing information in Section 2 about the person upon whose alimony, support or maintenance payments or income or assets you are relying. If this statement relates to your guaranty of the indebtedness of other person(s), firm(s) or corporation(s), complete Sections 1 and 3. To: COAST CENTRAL CREDIT UNION SECTION 1 INDIVIDUAL INFORMATION (TYPE OR PRINT) SECTION 2 OTHER PARTY INFORMATION Name Name Residential Address Residential Address City, State & Zip City, State & Zip Social Security Number -- -- Social Security Number -- -- Date of Birth / / Date of Birth / / Position or Occupation Business Name Business Address City, State & Zip Position or Occupation Business Name Business Address City, State & Zip H Phone ( ) - Bus Phone ( ) - H Phone ( ) - Bus Phone ( ) - SECTION 3 STATEMENT OF FINANCIAL CONDITION: AS OF: (DATE) / / ASSETS IN DOLLARS LIABILITIES IN DOLLARS (Do not include assets of doubtful value) (Omit cents) (Omit cents) Cash with Coast Central Credit Union - Sched A Revolving debt outstanding Cash on hand and in Other Fin Inst - Sched A Unpaid income tax U.S. Gov t./marketable Securities - Schedule B Other unpaid taxes and interest Cash Value-Life Insurance Schedule C Real Estate Owned Schedule D Notes / Loans Receivable Retirement Accounts / IRAs Vehicles and RVs Equipment Non-marketable Securities Schedule E Personal Property Other Assets itemize TOTAL ASSETS Notes Payable (other than real estate)--sched F Real Estate Mortgages Payable Schedule D Vehicle/RV loans Other Debts itemize TOTAL LIABILITIES NET WORTH (Total Assets minus Total Liabilities) TOTAL LIABILITIES AND NET WORTH SOURCES OF INCOME FOR THE YEAR ENDED PERSONAL INFORMATION Salary, Bonuses and Commissions Do you have a will? If so, name of executor. Dividends Are you a partner or officer in any other venture? If so, describe. Real Estate Income Are you obligated to pay alimony, child support or separate maintenance payments? If so, describe. Other Income (Alimony, child support, or separate maintenance. Income need not be revealed if you do not wish to have it considered as a basis for Are any assets pledged other than as described on schedules? If so, describe. repaying this obligation.) TOTAL INCOME Income tax settled through (date)
Do you have any contingent liabilities? If so, describe. As endorser, co-maker or guarantor? On leases or contracts? Legal claims / other special debt Amount of contested income tax liens Are you a defendant in any suits or legal actions? Personal bank accounts carried at: Have you ever been declared bankrupt? If so, describe on separate sheet. Are any of your assets held in a Trust? If so, please describe, and provide a copy of the Trust Declaration Page. PLEASE COMPLETE SCHEDULES BELOW (attach separate sheet if needed) SCHEDULE A CASH DEPOSIT ACCOUNTS ACCOUNT TITLE FINANCIAL INSTITUTION ACCOUNT TYPE AVERAGE BALANCE ACCOUNT TITLE FINANCIAL INSTITUTION ACCOUNT TYPE AVERAGE BALANCE NUMBER OF SHARES OR FACE VALUE (BONDS) SCHEDULE B U.S. GOVERNMENT AND MARKETABLE SECURITIES DESCRIPTION IN NAME OF ARE THESE PLEDGED? SCHEDULE C LIFE INSURANCE CARRIED, INCLUDING N.S.L.I. AND GROUP INSURANCE NAME OF INSURANCE COMPANY OWNER OF POLICY BENEFICIARY FACE AMOUNT OF POLICY LOANS ON POLICY ADDRESS & TYPE OF PROPERTY TITLE IN NAME OF DATE ACQUIRED NUMBER OF SHARES DESCRIPTION SCHEDULE D REAL ESTATE OWNED PERCENT OWNERSHIP SCHEDULE E NON-MARKETABLE SECURITIES ARE THESE IN NAME OF PLEDGED? AMOUNTS BASED ON % OF OWNERSHIP INTEREST ORIGINAL COST MARKET VALUE MORT. AMOUNT % % % % % SOURCE OF VALUE MARKET VALUE CASH SURRENDER VALUE PMT. AMOUNT SCHEDULE F NOTES PAYABLE (OTHER THAN REAL ESTATE) NAME & ADDRESS OF LENDER SECURED/UNSECURED? ORIGINAL DATE HIGH CREDIT CURRENT BALANCE PMT AMT SCHEDULE G BANKS OR FINANCE COMPANIES WHERE CREDIT HAS BEEN OBTAINED SECURED / NAME & ADDRESS OF LENDER CREDIT IN THE NAME OF ORIGINAL DATE HIGH CREDIT CURRENT BALANCE PMT AMT UNSEC? THE INFORMATION CONTAINED IN THIS STATEMENT IS PROVIDED FOR THE PURPOSE OF OBTAINING OR MAINTAINING CREDIT WITH YOU ON BEHALF OF THE UNDERSIGNED, OR PERSONS, FIRMS OR CORPORATIONS IN WHOSE BEHALF THE UNDERSIGNED MAY EITHER SEVERALLY OR JOINTLY WITH OTHERS, EXECUTE A GUARANTY IN YOUR FAVOR. EACH UNDERSIGNED UNDERSTANDS THAT YOU ARE RELYING ON THE INFORMATION PROVIDED HEREIN (INCLUDING THE DESIGNATION MADE AS TO OWNERSHIP OF PROPERTY) IN DECIDING TO GRANT OR CONTINUE CREDIT. EACH UNDERSIGNED REPRESENTS AND WARRANTS THAT THE INFORMATION PROVIDED IS TRUE AND COMPLETE AND THAT YOU MAY CONSIDER THIS STATEMENT AS CONTINUING TO BE TRUE AND CORRECT UNTIL A WRITTEN NOTICE OF A CHANGE IS GIVEN TO YOU BY THE UNDERSIGNED. YOU ARE AUTHORIZED TO MAKE ALL INQUIRIES YOU DEEM NECESSARY TO VERIFY THAT ACCURACY OF THE STATEMENTS MADE HEREIN, AND TO DETERMINE MY/OUR CREDITWORTHINESS. YOU ARE AUTHORIZED TO ANSWER QUESTIONS ABOUT YOUR CREDIT EXPERIENCES WITH ME/US. VALUE Signature (Individual) Dated Signature (Other Party) Dated http://coastnet/departments/loandept/businessservices/application Forms/PERSONAL FINANCIAL STATEMENT.doc Revised 1-7-08 DJS Page 2 of 2
CERTIFICATION REGARDING BENEFICIAL OWNERS OF LEGAL ENTITY CUSTOMERS I. GENERAL INFORMATION What is this form? To help the government fight financial crime, Federal regulation requires certain financial institutions to obtain, verify, and record information about the beneficial owners of legal entity customers. Legal entities can be abused to disguise involvement in terrorist financing, money laundering, tax evasion, corruption, fraud, and other financial crimes. Requiring the disclosure of key individuals who own or control a legal entity (i.e., the beneficial owners) helps law enforcement investigate and prosecute these crimes. Who has to complete this form? This form must be completed by the person opening a new account on behalf of a legal entity with any of the following U.S. financial institutions: (i) a bank or credit union; (ii) a broker or dealer in securities; (iii) a mutual fund; (iv) a futures commission merchant; or (v) an introducing broker in commodities. For the purposes of this form, a legal entity includes a corporation, limited liability company, or other entity that is created by a filing of a public document with a Secretary of State or similar office, a general partnership, and any similar business entity formed in the United States or a foreign country. Legal entity does not include sole proprietorships, unincorporated associations, or natural persons opening accounts on their own behalf. What information do I have to provide? This form requires you to provide the name, address, date of birth and Social Security number (or passport number or other similar information, in the case of non-us persons) for the following individuals (i.e., the beneficial owners): i. Each individual, if any, who owns, directly or indirectly, 25 percent or more of the equity interests of the legal entity customer (e.g., each natural person that owns 25 percent or more of the shares of a corporation); and ii. An individual with significant responsibility for managing the legal entity customer (e.g., a Chief Executive Officer, Chief Financial Officer, Chief Operating Officer, Managing Member, General Partner, President, Vice President, or Treasurer). The number of individuals that satisfy this definition of "beneficial owner" may vary. Under section (i), depending on the factual circumstances, up to four individuals (but as few as zero) may need to be identified. Regardless of the number of individuals identified under section (i), you must provide the identifying information of one individual under section (ii). It is possible that in some circumstances the same individual might be identified under both sections (e.g., the President of Acme, Inc. who also holds a 30% equity interest). Thus, a completed form will contain the identifying information of at least one individual (under section (ii)), and up to five individuals (i.e., one individual under section (ii) and four 25 percent equity holders under section (i)). The financial institution may also ask to see a copy of a driver's license or other identifying document for each beneficial owner listed on this form.
II. CERTIFICATION OF BENEFICIAL OWNER(S) Persons opening an account on behalf of a legal entity must provide the following information: a. Name and Title of Natural Person Opening Account: Name: Title: b. Name, Type and Address of Legal Entity for Which the Account is Being Opened: Name: Type: Address: c. The following information for each individual, if any, who, directly or indirectly, through any contract, arrangement, understanding, relationship or otherwise, owns 25 percent or more of the equity interests of the legal entity listed above: Name Date of Birth Address (Residential/Bu siness) US Person (SSN) Non-US Person 1 % Ownership d. The following information for one individual with significant responsibility for managing the legal entity listed above, such as: - An executive officer or senior manager (e.g., Chief Executive Officer, Chief Financial Officer, Chief Operating - Officer, Managing Member, General Partner, President, Vice President, Treasurer); or Any other individual who regularly performs similar functions. (If appropriate, an individual listed under section (c) above may also be listed in this section (d)). Name Date of Birth Address (Residential/Busin ess) US Person (SSN) Non-US Person 1
RECERTIFICATION: CERTIFICATE OF DEPOSIT (CD) ACCOUNTS Beneficial ownership information must be collected for each new account opening. As a CD rollover constitutes a new account opening according to the regulations, and to ensure that up-to-date information is maintained for each CD account, by signing below you also agree to notify the financial institution of any changes to the beneficial ownership information provided herein. Not applicable; not a CD account. RECERTIFICATION: COMMERCIAL LOAN ACCOUNTS ACCOUNTS Beneficial ownership information must be collected for each new account opening. As a loan renewal constitutes a new account opening according to the regulations, and to ensure that up-to-date information is maintained for each loan account, by signing below you agree that the beneficial ownership information originally provided when opening the loan account remains valid as of this date. Not applicable; not a commercial loan account. I, (name of natural person opening account), hereby certify, to the best of my knowledge, that the information provided above is complete and correct. Signature: Date: Legal Entity Identifier: 1 In lieu of a passport number, non-us persons may also provide a Social Security Number (SSN), an alien identification card number, or number and country of issuance of any other government-issued document evidencing nationality or residence and bearing a photograph or similar safeguard. Created on: 29-May-2018
ADDENDUM A TO VISA VARIABLE AND FIXED RATE CLASSIC CARDS AND FEDERAL TRUTH-IN-LENDING DISCLOSURE STATEMENT The Coast Central Credit Union VISA Variable and Fixed Rate Classic and Platinum Card Agreement and Federal Truth-In-Lending Disclosure Statement are incorporated herein as set forth in full. The rates and terms are set forth below. The following applies only to VISA Variable Rate Classic Card Accounts: The Initial Rate used in calculating the monthly INTEREST CHARGE is the Monthly Periodic Rate of 0.766% (corresponding initial ANNUAL PERCENTAGE RATE OF 9.200%). There is no minimum ANNUAL PERCENTAGE RATE during the term of this agreement. The index as of the date of the agreement is 5.00%. The following applies only to VISA Fixed Rate Classic Card Accounts: The Monthly Periodic Rate for your account is 1.246% (corresponding ANNUAL PERCENTAGE RATE OF 14.95%). Please note that there are no fees on balance transfers. There is a fee for cash advances of 2% or 10, whichever is greater. Please see reverse for Addendum A to Visa Variable and Fixed Rate Platinum Cards. Visa Rate Effective 09/11/18 ADDENDUM A TO VISA VARIABLE AND FIXED RATE CLASSIC CARDS AND FEDERAL TRUTH-IN-LENDING DISCLOSURE STATEMENT The Coast Central Credit Union VISA Variable and Fixed Rate Classic and Platinum Card Agreement and Federal Truth-In-Lending Disclosure Statement are incorporated herein as set forth in full. The rates and terms are set forth below. The following applies only to VISA Variable Rate Classic Card Accounts: The Initial Rate used in calculating the monthly INTEREST CHARGE is the Monthly Periodic Rate of 0.766% (corresponding initial ANNUAL PERCENTAGE RATE OF 9.200%). There is no minimum ANNUAL PERCENTAGE RATE during the term of this agreement. The index as of the date of the agreement is 5.00%. The following applies only to VISA Fixed Rate Classic Card Accounts: The Monthly Periodic Rate for your account is 1.246% (corresponding ANNUAL PERCENTAGE RATE OF 14.95%). Please note that there are no fees on balance transfers. There is a fee for cash advances of 2% or 10, whichever is greater. Please see reverse for Addendum A to Visa Variable and Fixed Rate Platinum Cards. Visa Rate Effective 09/11/18 ADDENDUM A TO VISA VARIABLE AND FIXED RATE CLASSIC CARDS AND FEDERAL TRUTH-IN-LENDING DISCLOSURE STATEMENT The Coast Central Credit Union VISA Variable and Fixed Rate Classic and Platinum Card Agreement and Federal Truth-In-Lending Disclosure Statement are incorporated herein as set forth in full. The rates and terms are set forth below. The following applies only to VISA Variable Rate Classic Card Accounts: The Initial Rate used in calculating the monthly INTEREST CHARGE is the Monthly Periodic Rate of 0.766% (corresponding initial ANNUAL PERCENTAGE RATE OF 9.200%). There is no minimum ANNUAL PERCENTAGE RATE during the term of this agreement. The index as of the date of the agreement is 5.00%. The following applies only to VISA Fixed Rate Classic Card Accounts: The Monthly Periodic Rate for your account is 1.246% (corresponding ANNUAL PERCENTAGE RATE OF 14.95%). Please note that there are no fees on balance transfers. There is a fee for cash advances of 2% or 10, whichever is greater. Please see reverse for Addendum A to Visa Variable and Fixed Rate Platinum Cards. Visa Rate Effective 09/11/18
ADDENDUM A TO VISA VARIABLE AND FIXED RATE PLATINUM CARDS AND FEDERAL TRUTH-IN-LENDING DISCLOSURE STATEMENT The Coast Central Credit Union VISA Variable and Fixed Rate Classic and Platinum Card Agreement and Federal Truth-In-Lending Disclosure Statement are incorporated herein as set forth in full. The rates and terms are set forth below. The following applies only to VISA Variable Rate Platinum Card Accounts: The Initial Rate used in calculating the monthly INTEREST CHARGE is the Monthly Periodic Rate of 0.683 (corresponding initial ANNUAL PERCENTAGE RATE OF 8.20%). There is no minimum ANNUAL PERCENTAGE RATE during the term of this agreement. The index as of the date of the agreement is 5.00%. The following applies only to VISA Fixed Rate Platinum Card Accounts: The Monthly Periodic Rate for your account is 1.163% (corresponding ANNUAL PERCENTAGE RATE OF 13.95%). Please note that there are no fees on balance transfers. There is a fee for cash advances of 2% or 10, whichever is greater. Please see reverse for Addendum A to Visa Variable and Fixed Rate Classic Cards. Visa Rate Effective 09/11/18 ADDENDUM A TO VISA VARIABLE AND FIXED RATE PLATINUM CARDS AND FEDERAL TRUTH-IN-LENDING DISCLOSURE STATEMENT The Coast Central Credit Union VISA Variable and Fixed Rate Classic and Platinum Card Agreement and Federal Truth-In-Lending Disclosure Statement are incorporated herein as set forth in full. The rates and terms are set forth below. The following applies only to VISA Variable Rate Platinum Card Accounts: The Initial Rate used in calculating the monthly INTEREST CHARGE is the Monthly Periodic Rate of 0.683% (corresponding initial ANNUAL PERCENTAGE RATE OF 8.20%). There is no minimum ANNUAL PERCENTAGE RATE during the term of this agreement. The index as of the date of the agreement is 5.00%. The following applies only to VISA Fixed Rate Platinum Card Accounts: The Monthly Periodic Rate for your account is 1.163% (corresponding ANNUAL PERCENTAGE RATE OF 13.95%). Please note that there are no fees on balance transfers. There is a fee for cash advances of 2% or 10, whichever is greater. Please see reverse for Addendum A to Visa Variable and Fixed Rate Classic Cards. Visa Rate Effective 09/11/18 ADDENDUM A TO VISA VARIABLE AND FIXED RATE PLATINUM CARDS AND FEDERAL TRUTH-IN-LENDING DISCLOSURE STATEMENT The Coast Central Credit Union VISA Variable and Fixed Rate Classic and Platinum Card Agreement and Federal Truth-In-Lending Disclosure Statement are incorporated herein as set forth in full. The rates and terms are set forth below. The following applies only to VISA Variable Rate Platinum Card Accounts: The Initial Rate used in calculating the monthly INTEREST CHARGE is the Monthly Periodic Rate of 0.683% (corresponding initial ANNUAL PERCENTAGE RATE OF 8.20%). There is no minimum ANNUAL PERCENTAGE RATE during the term of this agreement. The index as of the date of the agreement is 5.00%. The following applies only to VISA Fixed Rate Platinum Card Accounts: The Monthly Periodic Rate for your account is 1.163% (corresponding ANNUAL PERCENTAGE RATE OF 13.95%). Please note that there are no fees on balance transfers. There is a fee for cash advances of 2% or 10, whichever is greater. Please see reverse for Addendum A to Visa Variable and Fixed Rate Classic Cards. Visa Rate Effective 09/11/18